Field Notes

Analysis Found Weight-Loss Surgery May Help People With Obesity Manage High Blood Pressure

People with obesity who underwent weight-loss surgery were more likely to control their high blood pressure over a one- to five-year follow-period compared to those who managed their high blood pressure with medications and lifestyle management, according to preliminary research presented at the American Heart Association’s Hypertension Scientific Sessions 2024.

Based on a combined analysis of data from 18 randomized controlled trials involving more than 1,300 participants, these findings confirm the positive results from previous research, the authors note.

“Our findings indicate bariatric surgery is a durable solution for obesity-related hypertension since it results in high blood pressure remission or long-term control while reducing the dependence on blood pressure medications. In addition, by improving blood pressure control, bariatric surgery also lowers the risk of cardiovascular disease and enhances overall heart health,” says study lead author Sneha Annie Sebastian, MD, a researcher and graduate of Azeezia Medical College in Kerala, India, and a residency candidate from Alberta, Canada.

Bariatric surgery helps people lose weight by reducing the size of the stomach so people feel full when eating less and may also include procedures that change the structure of the digestive system so fewer nutrients and calories are absorbed. According to the 2022 guidelines from the American Society for Metabolic and Bariatric Surgery and the International Federation for the Surgery of Obesity and Metabolic Disorders, bariatric surgery is recommended for people with a BMI of 35 kg/m2 or higher, regardless of presence, absence or severity of comorbidities.

The current analysis, combining data from 18 randomized controlled trials in several countries, compared more than 1,300 people with obesity and high blood pressure who were randomly selected to receive either bariatric surgery or a nonsurgical, medication, or lifestyle intervention. After an average follow-up period of one to five years, the researchers found that compared with the control group, participants who had weight-loss surgery:

were 2.77 times more likely to lower their blood pressure to less than 140/90 mm Hg, defined as blood pressure remission, without the need for blood pressure-lowering medication;
were 7.1 times more likely to lower their blood pressure to less than 130/80 mm Hg, defined as blood pressure control, while substantially reducing their use of blood pressure-lowering medications; and
lowered their systolic (top number) blood pressure by, on average, 3.67 mm Hg, compared with those in the medication and lifestyle management control group.

“Bariatric surgery is an effective solution for managing obesity-related hypertension. Future research should focus on conducting randomized controlled trials with long-term follow-up and large sample sizes, with a specific emphasis on hypertension outcomes, as many currently focus on diabetes outcomes. Furthermore, it’s essential to evaluate the efficacy and cost-effectiveness of different bariatric procedures for various patient profiles and to identify optimal candidates for each type of surgery,” Sebastian explains.

Study details, background, or design include the following:  

The final analysis included 18 studies with 1,386 participants older than age 18 with obesity (average BMI of 38 kg/m²), with primary or secondary outcomes reporting the effects of weight-loss surgery on blood pressure. 62.7% of participants identified as women, and 37.3% identified as men.
The studies were conducted between December 2002 and May 2024.
People in the bariatric surgery group had any of several procedures that make changes in the digestive system to facilitate weight loss. People in the control group were similar in obesity and high blood pressure but randomly selected for treatment with medication and lifestyle management rather than surgery.
The authors included multiple types of weight-loss surgeries; however, most of the studies focused on Roux-en-Y gastric bypass and sleeve gastrectomy.
Data from a subgroup of five studies were analyzed for hypertension remission and the use of medications; four of the five studies had hypertension as the primary outcome. At the beginning of the four studies, participants were taking maximal doses of at least two pressure-lowering medications.

The analysis is limited by differences among the trials in the baseline characteristics of the participants, the surgical techniques used, how obesity was diagnosed, and the length of follow-up. In addition, many of the studies didn’t have a large number of participants, and only four of the 18 studies focused on high blood pressure as the primary outcome. The authors note that these limitations may impact the generalizability and reproducibility of the findings.

“These findings underscore the beneficial impact of weight loss on blood pressure control—bariatric surgery consistently improved blood pressure control in individuals with obesity. Unfortunately, there are very limited data on the impact of surgical weight loss with the primary outcome of hypertension remission,” says Michael E. Hall, MD, MS, FAHA, chair of the writing group for the American Heart Association’s 2021 scientific statement on weight-loss strategies for prevention and treatment of hypertension and chair of the department of medicine at the University of Mississippi Medical Center in Jackson, Mississippi.

“Further, given the effectiveness of newer weight loss medications and beneficial effects on cardiometabolic conditions like hypertension, we need randomized clinical studies comparing bariatric surgery to these newer medications to decide which people are better suited for a specific weight-loss strategy,” Hall says. “Overall, bariatric surgery is an effective and durable treatment option for hypertension related to obesity.”

— Source: American Heart Association

Type 2 Diabetes Increased by Almost 20% Over a Decade

Type 2 diabetes increased by almost 20% between 2012 and 2022, according to a new study from the University of Georgia.

The researchers found an increase in diabetes among all sociodemographic groups. But non-Hispanic Black people were particularly hard hit by the disease, with just under 16% of Black study participants reporting being diagnosed with type 2 diabetes.

More than one in five individuals aged 65 or older had the condition. The same age group was more than 10 times as likely to be diagnosed with diabetes than people in the 18- to 24-year age bracket. People between the ages of 45 and 64 were over five times as likely to receive the diagnosis.

The study also found that individuals with lower incomes had a significantly higher prevalence of diabetes than their higher-income counterparts. People with high incomes were 41% less likely to be diagnosed with the disease, and individuals with a college education were 24% less likely to be given a diabetes diagnosis.

“Diabetes is increasing day by day in the US, and it will increase even more in the coming years,” says Sulakshan Neupane, lead author of the study and a doctoral student at the University of Georgia’s College of Agricultural and Environmental Sciences. “Diabetes costs around $412 billion, including medical costs and indirect costs like loss of productivity. That’s a huge amount, and it’s only going to increase as more people are diagnosed with the disease.”

South, Midwest Particularly Vulnerable to Diabetes
The researchers used data from the nationally representative Behavioral Risk Factor Surveillance System, an ongoing health survey of more than 400,000 people.

They relied on the same dataset for a paper published by the American Journal of Preventive Medicine in April, which emphasized the economic burden of type 2 diabetes and the increased prevalence of the condition over the same study period as the current paper.

In addition to other risk factors, the researchers found regional differences in diabetes prevalence as well.

The South and Midwest, in particular, experienced large jumps in the number of individuals with type 2 diabetes, with Arkansas, Kentucky, and Nebraska reporting the highest increases between 2012 and 2022.

Ten states saw increases of 25% or more over the decade-long study period: Arkansas, Kentucky, Nebraska, Texas, Alabama, Minnesota, Illinois, West Virginia, Delaware, and Massachusetts.

“In these areas, people are at higher risk of developing diabetes, so policymakers and public health officials need to focus on these regions,” Neupane explains.

Overweight, Obese Individuals More Likely to Have Diabetes
Overweight and obese participants were also more likely to report being diagnosed with type 2 diabetes. About one in five obese individuals reported having the disease in 2022 while one in 10 overweight participants reported having the condition.

Physical activity seemed to guard against diabetes to an extent, with physically active individuals facing a prevalence of under 10%, while inactive people experienced a rate closer to 19%.

“Identifying these risk factors and acting to mitigate them is key,” Neupane says. “Be more active. Pay more attention to your physical health. Some risk factors like age and race cannot be modified, but you can do something to lower risk of diabetes, like, healthful eating, maintaining an active lifestyle, and losing weight.”

— Source: University of Georgia